INTRODUCTION
Targeted therapies against the mitogen-activated protein (MAP) kinase pathway, known to contribute to tumorigenesis, have emerged to treat a variety of cancers.1 Mitogen-activated protein kinase kinase (MEK) inhibitors are FDA-approved for the management of melanoma, colorectal, and lung cancers that inhibit MEK1 and MEK2 activation.1 In a clinical trial, MEK inhibitor, trametinib, use in patients with relapsed or persistent low-grade serous ovarian cancer yielded improved progression-free survival compared with standard-of-care therapies.2 Trametinib is now used off-label to treat ovarian cancer with genetic alterations that increase MEK expression. Cutaneous adverse effects are the most frequent toxicity observed with MAP kinase pathway inhibitors. Adverse events are a common cause of targeted therapy dose interruption or reduction, thus highlighting dermatologic supportive care.3,4 This is the first reported case of inflammatory alopecia following MEK inhibitor use.
CASE REPORT
A woman in her 50s with a history of bilateral ovarian cancer presented to an oncodermatology clinic with a new rash on her forehead and scalp. She started trametinib, a MEK inhibitor, five months prior for platinum-resistant recurrent disease with a KRAS G12D mutation. On examination, a diffuse acneiform rash was noted on her frontal scalp (Figure 1). Hair was sparse in the affected areas. She reported significant pruritus of lesions and frequent crusting. Diagnosis of acneiform eruption was favored; treatment with topical triamcinolone and oral doxycycline was started.
